Viral Hepatitis and HIV

Hepatitis A

What Is Hepatitis A and How Is It Transmitted?

Hepatitis A is caused by the hepatitis A virus (HAV). HAV is spread from one person to another when the feces (shit) of someone with the virus gets into another person's mouth. People can be infected with HAV when they eat food -- particularly food that is raw or not thoroughly cooked -- that has been handled or prepared by someone who has hepatitis A (and may not know it). Drinking water or ice that is contaminated with feces is another possible source of infection, as are shellfish that have not been properly cooked. HAV can also be transmitted through "rimming" (oral-anal sex). Very rarely, HAV can be spread through blood-to-blood exposure.

Hepatitis A is an acute form of hepatitis, meaning that it does not cause long-term (chronic) infection. If you have had hepatitis A once, you cannot be infected with the virus again. However, you can still be infected with other hepatitis viruses.

What Are the Symptoms of Hepatitis A?

Not everyone who is infected with HAV will experience noticeable symptoms. For example, many babies and young children infected with HAV do not experience any symptoms of infection. Symptoms are much more likely to occur in older children, adolescents, and adults.

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Symptoms of hepatitis A (and acute hepatitis in general) can include:

Yellowing of the skin and whites of the eyes (jaundice)

Feeling tired and rundown (fatigue)

Pain in the upper-right abdomen

Loss of appetite

Weight loss

Fever

Nausea

Diarrhea

Vomiting

Dark urine and/or pale stool

Joint pain

HAV infection can also cause enzymes produced by the liver to increase above normal levels in the bloodstream (see Liver Enzyme Tests).

It can take the immune system up to eight weeks to clear HAV from the body. If symptoms occur, they usually do so within two to four weeks after being infected. The symptoms of hepatitis A can last anywhere from a week to more than a month. Approximately 15% of people with hepatitis A experience symptoms that last between six to nine months. About one out of 100 people infected with HAV may experience a quick and severe (fulminant) infection, which -- very rarely -- can lead to liver failure and death.

How Is Hepatitis A Diagnosed?

Hepatitis A can be diagnosed using blood tests. Your healthcare provider can order these tests if you have symptoms of hepatitis A or if you want to know if you were infected with HAV in the past.

The blood test looks for two different types of antibodies to the virus. First it looks for IgM antibodies, which are produced by the immune system five to ten days before symptoms appear and usually disappear within six months. It also looks for IgG antibodies, which replace IgM antibodies and protect against future HAV infection.

If the blood test shows that you are negative for both IgM and IgG antibodies, you probably have never been infected with the virus and should consider getting the HAV vaccine.

If you are positive for IgM antibodies and negative for IgG antibodies, HAV infection most likely took place within the past six months and is either in the process of being cleared by the immune system or getting worse.

If you are negative for IgM antibodies and positive for IgG antibodies, either you were infected with HAV some time in the past or you have been vaccinated against hepatitis A; in either case, you are now immune to the virus.

What About for People With HIV?

People with HIV are not at greater risk of becoming infected with HAV than anyone else. However, some studies suggest that people with HIV are more likely to experience prolonged symptoms of hepatitis A, meaning that it might take longer for someone who is HIV-positive to recover fully from hepatitis A.

Another important issue to consider is that many people with HIV are taking anti-HIV medications that can be toxic to the liver. Some of these medications can make symptoms of hepatitis A worse. In turn, it might be necessary to stop all anti-HIV medications until the hepatitis A has run its course or until liver enzyme levels have returned to normal. Talk with your healthcare provider before stopping any medications.

How Is Hepatitis A Treated?

The usual treatment for hepatitis A is bed rest. It is also important to drink plenty of fluids, particularly if you are experiencing diarrhea or vomiting. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, etc.), can help manage some of the symptoms of hepatitis A, although it's best to consult with your healthcare provider before using them.

If you think that you may have recently been exposed to HAV -- for example, if somebody in your household has been diagnosed with hepatitis A -- you can talk to your healthcare provider about receiving an injection of immune globulin (also called gamma globulin). Immune globulin contains high levels of antibodies to HAV, which can help prevent the disease if you have been exposed to the virus. Immune globulin needs to be given within two to six weeks after possible exposure to HAV. People who receive immune globulin to prevent active hepatitis A should also receive the hepatitis A vaccine (discussed below).

How Can Hepatitis A Be Prevented?

The best way to prevent hepatitis A is to be vaccinated. Two HAV vaccines are available: Havrix and VAQTA. Both of these vaccines require two injections, usually administered six months apart. If side effects from the hepatitis A vaccine occur, they are usually mild and may include soreness at the injection site and mild flu-like symptoms. A combination vaccine for HAV and hepatitis B virus (Twinrix) is also available.

The HAV vaccine is very effective -- more than 99% of people who are vaccinated develop immunity against the virus and will never get HAV even if they are exposed to it. There is some concern that people with HIV with suppressed immune systems are less likely to benefit from the vaccine, so it is best to get the vaccine when CD4 cell counts are within healthy ranges.

If you do not think you were ever infected with hepatitis A, talk to your healthcare provider about the vaccine. Because people with HIV often experience worse symptoms of HAV infection and the liver plays such an important role in breaking down anti-HIV medications, the hepatitis A vaccine is strongly recommended for people with HIV. Getting vaccinated is especially important for people coinfected with HIV and hepatitis B or hepatitis C.

Even if you haven't been vaccinated against hepatitis A, there are things you can do to prevent HAV infection:

Avoid water that could be contaminated with fecal matter.

Avoid undercooked or raw shellfish.

Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing and eating food.

Use a latex barrier -- such as a dental dam -- for oral-anal sex (rimming).

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